Eight years of clinical experience with digit replantation: Demographic characteristics and outcomes.

BACKGROUND: Despite surgical and technical advances in microsurgery, it is still difficult to obtain satisfactory results after replantation of finger amputation. The aim of the present study was to discuss some of the many factors that can affect the success rate of replantation. METHODS: A retrospective analysis of 60 patients with 85 finger replantations was performed. Revascularizations and replantations proximal to the metacarpophalangeal joint were excluded. Demographic characteristics of the patients, place of injury, mechanism of injury, level of amputation, and success rate were examined. RESULTS: A total of 53 male and 7 female patients with mean age of 31 years were included in the study. Index finger (27%) was the most commonly replanted digit. Left side was the more affected, with 62%. Mechanism of injury was crush in 56%, guillotine in 23%, and avulsion in 21% of replanted digits. Success rate was 81%, 53%, and 36% in guillotine, crush, and avulsion injuries, respectively. CONCLUSION: In conclusion, the injury type and personal variables are very important in the rate of replantation success. Knowledge about the effects of different factors on the results of replantation surgery will provide guidance to hand surgeons in order to inform patients and their relatives properly.

Tendon interposition and ligament reconstruction with ECRL tendon in the late stages of Kienböck's disease: a cadaver study.

BACKGROUND: The optimal surgical treatment for Kienböck's disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck's disease. METHODS: Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. RESULTS: It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. CONCLUSION: Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones.

V-Y rotation advancement fasciocutaneous flap for excisional defects of pilonidal sinus.

BACKGROUND: Pilonidal sinus is a common disease that mostly affects young people. Despite numerous treatment modalities, the best technique has not yet been determined and there are many recurrences, causing economic losses and serious discomfort for the patients. METHODS: The authors used V-Y rotation flaps for coverage of the defects after excision and debridement of chronic pilonidal sinuses in eight patients. The results were evaluated and compared with previously reported studies regarding the grade of disease at presentation, duration of surgery, blood loss, hospitalization period and active mobilization periods, complications, and loss of sensitivity. RESULTS: No major complications occurred; hospitalization and immobilization periods were acceptably convenient. Recurrence was not seen, and sensitivity of the gluteal region did not diminish. The outcome was also satisfactory regarding aesthetics, and all the patients were satisfied with the result. CONCLUSION: The authors believe that the V-Y rotation advancement flap is a good alternative method for the treatment of pilonidal sinus.

An alternative method to minimize pain in the split-thickness skin graft donor site.

In the art of plastic surgery, the reconstruction of tissue defects to obtain cosmetic and functional recovery is the major concern. Skin grafting is the most frequently used procedure for reconstructing defects of various size and anatomical localizations. On the other hand, donor-site problems associated with this invaluable procedure are inevitable. Various methods are used in the postoperative management of the partial-thickness donor site created during the harvest of a split-thickness skin graft. Each technique has the potential for complications of fluid loss, excessive pain, prolonged period of healing and immobilization, hypertrophic scarring, and undesirable pigmentation. Donor-site pain is probably the most disturbing complication in the early postoperative period. The aim of this article is to point out the significance of donor-site pain, which has not been emphasized thoroughly in the literature, and to introduce flap skin as a potential graft donor site for patients in whom reduction of donor-site morbidity is of primary concern. The principal goal of the technique described in this article is to eliminate donor-site pain by harvesting the graft from the flap that is insensate after the elevation. In 15 patients, the overlying skin of the flap that had been used for reconstructive purposes was used as the donor site (group I). In the remaining 23 patients, the posterolateral thigh was used as the donor site (group II). Donor-site discomfort was recorded during the first 8 days postoperatively using a visual analogue scale. To analyze the data, we used the Friedman test, Dunn's multiple comparison test, and Mann-Whitney U test. It was observed that the visual analogue scale of both of the groups showed a significant decrease within days (group I, p < 0.0001; group II, p < 0.0001). The mean pain scores were significantly lower in group I than in group II (p < 0.0001). When donor-site pain is of primary concern, this procedure provides uneventful and comfortable healing while avoiding postoperative pain in the donor site. For that reason, this technique might be used in appropriate cases to minimize donor-site pain.

The behavior of fat grafts in recipient areas with enhanced vascularity.

Fat grafts are used for soft-tissue augmentation of various anatomic regions, most frequently for the improvement of facial contours. Resorption of the graft is the main problem, and several different procedures have been described to minimize this phenomenon. Using 25 New Zealand rabbits, the behavior of fat grafts in a highly vascularized recipient site was studied. The recipient sites prepared on the backs of the rabbits were divided into four regions. A capsule formation with silicone sheet application was accomplished in two of these recipient areas before the transplantation of the fat grafts. Fat grafts were placed in the other two recipient areas without any prior preparation. We prepared two types of fat tissue; in one the lobular structure was preserved and in the other it was manually crushed and rinsed with lactated Ringer's solution. The fat tissues with preserved lobular structure were placed in area I and area III. Manually crushed and rinsed fat tissues were placed in area II and area IV. In areas III and IV, a capsule formation with silicone sheet had been accomplished 3 weeks before grafting. Biopsy samples were obtained from these sites at the end of the first, third, sixth, and tenth months. Our aim was to observe the histologic fate of fat tissue in different recipient areas. The macroscopic and microscopic evaluation of the fat grafts in areas with silicone sheet indicated significant differences in the resorption time of the fat grafts; however, it was concluded that the significant resorption of the transplanted autologous fat tissue grafts at the end of the first year was an inevitable consequence of fat grafting.